Provider Demographics
NPI:1285284463
Name:JONES, STACEY LYNETTE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 ABATIS WAY SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2891
Mailing Address - Country:US
Mailing Address - Phone:404-909-5815
Mailing Address - Fax:
Practice Address - Street 1:3609 ABATIS WAY SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2891
Practice Address - Country:US
Practice Address - Phone:404-909-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherDEPARTMENT OF VETERANS AFFAIRS